Durham Research Online Deposited in DRO: 28 July 2016 Version of attached le: Accepted Version Peer-review status of attached le: Peer-reviewed Citation for published item: Roberts, C. A. and Caell, A. and Filipek-Ogden, K. and Gowland, R. L. and Jakob, T. (2016) '`Til poison phosphorous brought them death' : a potentially occupationally-related disease in a post-medieval skeleton from north-east England.', International journal of paleopathology., 13 . pp. 39-48. Further information on publisher's website: http://dx.doi.org/10.1016/j.ijpp.2015.12.001 Publisher's copyright statement: c 2016 This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ Additional information: Use policy The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that: • a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders. Please consult the full DRO policy for further details. Durham University Library, Stockton Road, Durham DH1 3LY, United Kingdom Tel : +44 (0)191 334 3042 | Fax : +44 (0)191 334 2971 https://dro.dur.ac.uk ‘Til Poison Phosphorous Brought them Death’: A potentially occupationally-related disease in a post-medieval skeleton from north-east England. Charlotte A Roberts, Anwen Caffell, Kori L Filipek-Ogden, Rebecca Gowland, Tina Jakob Department of Archaeology, Durham University, South Road, Durham, DH1 3LE [email protected] [email protected] [email protected] [email protected] [email protected] Corresponding author: [email protected](+441913341154) 1 Abstract This paper describes the pathological changes observed on the skeleton of a c.12-14 year old person buried in a north-east England Quaker cemetery dated to AD 1711-1857. Bone formation (woven and lamellar) and destruction are present mainly in the mandible, clavicles, sternum and scapulae, long bones of the right arm, left ribs, spine, ilia, and the femora and tibiae. Differential diagnoses of tuberculosis and other pulmonary disease, smallpox, actinomycosis, neoplastic disease, and “phossy jaw” are considered. While the pathological changes could represent all previously described diseases, and be associated with the insalubrious conditions in which this person lived, it is also possible that this person worked in the matchmaking industry known to be present in the region at the time. Attention is drawn to the previously overlooked condition “phossy jaw” caused by phosphorus poisoning, which was strongly associated with this industry. While matchstick making was an industry often associated with women and girls, DNA analysis of a bone sample did not successfully identify biological sex. Two dental calculus samples from this person were analysed for phosphorus, and comparisons were made with samples from the same and a different site; the levels did not indicate the person was exposed to phosphorus more than any of the other people. However, the pathological lesions described also have relevance in a clinical context, because “phossy jaw” has been observed in living populations, arising as a consequence of ingesting phosphorous contained within some pharmaceuticals used for treating neoplastic disease and osteoporosis. Keywords: “phossy jaw”; dental; infectious; metabolic; matchmaking, Coach Lane, North Shields 2 1. Introduction Work has always been part of everyday life, whether this purely involved the procurement of food for survival or working in specific industries. Ideally, employment also provides an environment conducive for the social well being and good health of the employed. The impact of work on skeletal health has been of interest to bioarchaeologists for many years, and investigated using various approaches and types of data (see Table 1). Indeed, support for such studies has been aided by “quick reference” texts (e.g. Capasso et al 1998) that facilitate identification of specific “occupations”. Type of approach Example Reference Metrical analysis Handedness Stirland 1993, Weiss 2009a Biomechanical analysis Impact of “activity” and Ruff 2008, Shaw and environment Stock 2009 Osteoarthritis Workload Klaus et al 2009, Walker and Hollimon 1989 Entheseal changes Impact of workload on Cashmore and soft tissues Zakrzewski 2013, Villotte et al 2010 Fractures Clay shoveler’s fracture Knüsel et al 1996 Spondylolysis Weiss 2009b Dental analysis Activity-related tooth Larsen 1985, Turner modification and Anderson 2003 Non-metric traits Auditory exostoses Crowe et al 2010 Specific indicators of Exposure to mining Oakberg et al 2000 occupation ‘pollution’ Multiple indicators Osteoarthritis and Molnar et al 2011 entheseal change Table 1 Summary of previous work exploring “occupation” through bioarchaeology However, there has also been a more critical appraisal of the value and rigor of such studies (e.g. see Waldron 1994, Jurmain 1999, Jurmain and Roberts 2008, Jurmain et al 2012, Meyer et al 2011, Henderson and Cardoso 2013). All of these “markers” in the skeleton can be caused by a number of variables. For example, osteoarthritis and entheseal changes are a feature of increasing age, and therefore the direct association between bone changes and specific 3 “occupations” is now being approached more cautiously. Using multiple markers (and controlling for age) to see if different sets of data produce the same conclusions can be used to mitigate the biases involved when only one “class” of information is studied, for example osteoarthritis. Additionally, various questions related to the work that people did in the past need to be considered, alongside the “markers” identified: for example, at what age did the person start work, was it their only job, how long each day did they perform the task, and was the work seasonal. A more fruitful way of exploring the impact of different types of “activity” on the skeleton, would be to work from the premise of the known impact that specific occupations have on the bones and teeth of those who did the work. While this paper uses the traditional bioarchaeological approach of recording pathological changes in skeletal remains and producing differential diagnoses, it then links these skeletal lesions to a specific occupation known to have been practiced in the time and place this person lived. Therefore, the aim of this paper is to present some unusual pathological changes in a skeleton from a post-medieval Quaker burial site in north-east England, discuss potential differential diagnoses, and consider possible causes, including the impact of a specific occupation. 2. Material and methods 2.1 The skeleton studied The skeleton (Burial 69 [516]) was excavated in 2010 by Pre-Construct Archaeology Ltd (PCA 2012, Proctor et al 2014) from Coach Lane, North Shields, North Tyneside, a Quaker burial ground dated to c.1711-1857 AD (Figures 1 and 2). Two hundred and forty-four individual graves and 18 charnel features, with 236 skeletons and several hundred disarticulated bones were recovered (Figure S1). Over half the skeletons were adults of mid/older age (Langthorne 2011), and a large percentage of the non-adults were five years or less at death; there were approximately equal numbers of adult males and females. The Quaker movement was founded in 1652 in north-west England. It represented members of a family of Christian religious movements collectively known as the Religious Society of Friends. The social status of the people from this burial population is not yet known, but the Quakers were devoted to peaceful principles, and adopted plain dress, speech and living, in order to separate themselves from, what they believed to be, a corrupt world (Dandelion 2008). 2.2 Context The period in which these people lived and died in North Shields was one of ‘massive changes in all spheres of human activity and experience, including health and disease’ (Roberts and Cox 2003:358). The post-medieval period in England heralded dramatic population growth (excess of births over deaths), migration, urbanization, industrialization and the commercialization of agriculture. 4 By 1850, 50% of the population lived in urban contexts (Scott and Duncan 1998), with immigration to towns and cities driven by the demand for a large work force in industrial centers. Developments in transport affected markets and commerce and the distribution of foodstuffs, the mobility of people, the introduction of new pathogens and exposure of immigrants to new diseases (Roberts and Cox 2003:287-358). Coastal towns and cities, like North Shields and Newcastle-upon- Tyne, also experienced an expansion in sea trade, transformed by the introduction of steam engines and the enlargement of existing harbors, and the establishment of new ones. However, this was not a time of economic prosperity for all; inequalities in wealth distribution increased and the real wages of unskilled laborers did not improve until the middle of the 19th century (Feinstein, 1998). The industrialized cities in the north of England tended to be focused on particular industries such as coal or cotton, with air and water often being polluted. Problems of waste disposal exacerbated the challenges of polluted and crowded living conditions. This was accompanied by poor quality housing, sanitation and working conditions, and there was often much poverty, with under- and malnutrition (1833, Chadwick 1842). The dreadful living conditions endured by the poor in many cities, including suburban areas, led to the introduction of a series of public health acts in the later 19th century (Sretzer 1988, Tulchinsky and Varavikova 2009). In particular, ‘the post-medieval (1540-1900) period in the North-East was one of radical and deep-rooted change, perhaps more so than any other period’ (Petts and Gerrard 2006:85).